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Wednesday 2 July 2008
Letters: 'Interfering' state
We all resent the 'interfering' state – until we need it
Steve Richards is right when he says "people still look to the state in their hour of need" (Opinion, 1 July), but he does not mention the other side of the coin – nobody wants to live by its rules.
We talk of tax as a burden rather than a responsibility or a contribution. We are not going to have the government tell us what to eat, how much to drink, what to do with our money or where to live – but when the Christmas club founders, the bank collapses, the rains come or cancer strikes, we ask why we weren't warned, why we were allowed this option, why firms were allowed to build there, what about our entitlement to the latest expensive drug – and so on until we hit our sixties and can campaign to have the state pay our care bills while we plot how to avoid inheritance tax.
We want accountability without bureaucracy, crime prevention without surveillance, discipline without enforcement, improved public service without higher taxation. We bewail the loss of community spirit while insisting that our every personal preference be fully respected, and never stop to consider to what extent these wants are compatible.
I used to laugh at the cynic's saying that a liberal was a conservative who had been to prison, while a conservative was a liberal who had been mugged, but it seems sadly true now, when principle has been forgotten and we seem, as a people, to be driven by expediency and selfishness.
NHS goes back to first principles
It is good at one's 60th birthday to look back, judge one's life, then on that judgement move forward – so with the NHS.
Your headline "Pick your own surgeon – a new future for the NHS" (1 July) is somewhat misleading. Those of us working in the NHS 50 years ago (and still involved in research) remember that patients did then have choice of consultant, usually informed by their family doctor, a truly general practitioner with holistic knowledge of the patient, their family and their lifestyle, and with technical knowledge of appropriate specialists available. So this is not new, but a welcome return to the days before a series of desperate and uninformed reforms, scribbled out on the back of a cigarette packet and as potentially harmful as its contents.
Perhaps the start of these untested and often counter-productive reforms was the purchaser/provider split. The idea was to increase competition between providers of health care – particularly hospitals. In fact competition was already dangerously strong, especially between the prestigious London-based units. The split not only worsened this but doubled the number of managers in many fields, thus wasting vast sums of money intended for patient care. Yet this idea was soundly backed by the three main political parties.
Many of the suggested changes, most returning to past ideas, are to be welcomed. Among the new ideas, properly funding and staffing NICE would be excellent. But beware polyclinics (which would threaten the holistic GP – the golden foundation of our health service), until they have been properly tried in this country.
John Atkins FRCOG
Swainby, North Yorkshire
Andy McSmith's report on the NHS (28 June) demands comment. After six years' wartime service in the Army, I was privileged to read Bevan's White Paper outlining the proposed NHS – and to contribute to a discussion document prepared by the Fellowship for Freedom in Medicine.
McSmith writes that GPs "would retain the freedom to run their practices as small businesses." What he does not say is that part of the appropriate Act of Parliament made the purchase and sale of goodwill in the practice illegal: any GP signing his contract with the state prior to the initiation of the service would have his capital investment refunded, but not until his retirement. Anyone signing after the due date would have his investment confiscated. This was nothing short of blackmail on Bevan's part.
In order to win over undecided consultants, Bevan instituted a three-tier system of "merit awards" for a substantial proportion of consultants – at top level doubling their salary – to those signing their contracts by the due date. This bribery is what he bragged about publicly as having "stuffed their mouths with gold."
Bevan's estimate for the cost of the NHS was £19m per annum, and he assured the public that this would fall as the nation's health improved. McSmith suggests that it is advances in medical science which have pushed up costs so alarmingly. In truth the disgraceful rise in administrative costs has contributed to this to a far higher degree.
Dr John K Paterson
While a front-page feature on "A Surgical Revolution" ("A checklist that could prevent thousands of deaths", 25 June) is to be welcomed, our research over the past five years into teamwork in surgery shows that the checklist in itself is not really the point. What is important is the quality of its implementation.
The ideal is a full team briefing that sets out to create a safe climate for open communication. We know that around 70 per cent of medical errors are grounded in miscommunications within and across teams. Half of these errors could be avoided through formal briefing that explicitly sets up "situational awareness" – an understanding of how the surgical list will play out during the day and how all team members can contribute towards the safety of the patient. This goes beyond the requirements to report name and role, and explicitly sets out to empower those traditionally lower on the hierarchy who may often not speak out in a more restricted checklist brief run by the surgeon. The brief should be complemented by a debriefing.
Peninsula College of Medicine and Dentistry, Royal Cornwall Hospital, Truro, Cornwall
Spirit of cricket never more at risk
Following the incident at The Oval last week involving England captain Paul Collingwood, I would strongly urge the world of cricket to adopt wholeheartedly the "Spirit of Cricket" philosophy as conceived by my late father, Colin, Lord Cowdrey of Tonbridge.
We are entering the most exciting period in the game's history but also the most dangerous. What happened against New Zealand could be just a taster. If the authorities do not act now, this kind of unsporting incident will become commonplace throughout the world. In the next 12 months we have the Ashes Series here in England, the IPL, the Stanford series and the 20:20 World Cup; the money pouring into the global game is breathtaking and it is wonderful to see such investment.
However, with the stakes higher, there is no doubt the conduct of the players on the field of play will be tested. Where there is money there is avarice, and avarice will kill our game if we remain complacent.
My father saw this coming as far back as 1999. He grew increasingly worried that cricket would go the way of football, where unsporting behaviour on the pitch is now commonplace. Football is in dire shape – and much of that is down to money. The lack of respect shown towards the officials and towards fellow players and towards the fans has been worsening for years, with no intervention from those who supposedly run the sport. Will cricket abjectly follow football or will it stand up and lead?
Lalit Modi took a brave decision to include the Spirit of Cricket in the IPL. Acutely aware that millions of children would be watching the IPL around the globe, he was determined all his players respected the game. And it worked, proving to those who feel that this message is outdated are woefully misguided.
Don't rush to alter law on witnesses
The Government has characteristically responded to the judgment of the House of Lords concerning the use of anonymous witnesses with the promise of a swift review of the law.
Before rushing to do so they would be well advised to consider the judgment of the court, which suggested that convictions based primarily upon the evidence of such witnesses (where effective cross-examination as to the potential motive for fabrication is made impossible) are likely to amount to a violation of Article 6 of the European Convention in any event.
It seems likely, therefore, that any emergency legislation will be rendered meaningless.
Jack Straw, our Justice Minister, said: "There is a difficult balance to strike here, between giving witnesses who fear for their safety the confidence to give evidence in court and ensuring that innocent people are not convicted". Yes indeed. And the difficult balance requires considerable thought, weighing of pros and cons, and careful drafting of any statutory change deemed necessary. Perhaps two years in total.
Our "Justice" Minister goes on: "I am looking at the issue with urgency and hope to make further announcements over the next few days". Will that be the setting up of an independent working party or commission with a wide remit? I fear not. More likely a statutory sticking plaster and an infected one at that, further reducing civil liberties.
He fears releasing a few people, believed to be bad criminals, but no longer so beyond reasonable doubt. We have always released some such people, by the nature of the standard of proof needed to convict. Grow up, government, do some proper governing, stop tabloid-worship.
Eco-towns take off into realm of myth
The eco-town (The Big Question, 1 July) is a government myth that has come to pass through a great deal of subterfuge. It started with reclassifying old airfields as "brownfield" sites.
This may seem to some academic, but most Second World War airfields have long returned to agriculture. In the case of Weston Otmoor, the airfield is just a big grass field that at the moment is used for military parachute training. By no stretch of the imagination could this grass field be called a "brown field" by anyone except this government.
The Coltishall development is also deeply flawed. Norwich needs an airport and the one that they have is situated in the suburbs and the runway is too short. In contrast, the RAF Coltishall site has a long runway and all the technical equipment, except for a terminal building, to support a viable airport away from nearby housing.
If this was to be a true eco-town then the present Norwich airport would be the site of the eco-town and Coltishall the new Norwich airport.
Hughenden Valley, Buckinghamshire
Business crime list can be challenged
I am writing in response to your article (13 June) concerning the National Staff Dismissal Register (NSDR). Action Against Business Crime and Hicom Business Solutions have worked with the Information Commissioner's Office for some 15 months to develop the NSDR.
The NSDR will only contain details of persons who have been dismissed or have resigned while under investigation for theft, fraud forgery or criminal damage to the property of their employer. Any person whose details are entered on the register will have been through an internal disciplinary procedure, with the opportunity to contest the allegations.
All persons whose details are entered on the NSDR will be informed of this and will be able to exercise rights of subject access to view the data and challenge any inaccuracy. They have the right to have inaccurate data amended or deleted. In a case where there is a dispute as to the relevance or accuracy of data, the subject has the right of appeal to the Information Commissioner.
The NSDR is not a blacklist, which can be accomplished informally and by consensus of authority figures and does not necessarily require an overt written record. A person will not be refused a job solely on the basis of his or her entry on the NSDR. All employer members of the NSDR must have in place properly structured recruitment, disciplinary and dismissal processes.
Chief Executive, Action Against Business Crime, London, SW1
Men who do dishes
In the light of the current rising incidence of male washday hands, I find Granville Stout's reckless Marigold-free activities reprehensible (letter, 1 July). The protective qualities of liquid soap are an old wives' tale. He should act responsibly, don the rubber and practise safe washing up.
As analysis dwells upon the lack of success of Gordon Brown after his first year as Prime Minister, should we not also look at the progress made by Tony Blair in his role as international envoy to the Middle East? For I fear that the outcome might be very similar – apart from the fact that Mr Blair has made more money in his spare time.
Seaford, East Sussex
Offended by 'gay' ad
Deborah Orr (28 June) accuses Stonewall and others of assuming that a Heinz advert featuring a same-sex kiss is "sexual" and of a lack of proportion in response to its withdrawal. She's wrong. It was Heinz, not anyone else, who announced withdrawal of the ad (which actually just included a funny gag) because of complaints from fundamentalist Christians about its "homosexual" content. And it's hardly disproportionate for Stonewall or anyone else to suggest that individuals are entitled to act as ethical consumers, spending their money with businesses that are not discourteous to them.
Chief Executive, Stonewall, London SE1
Not only smacking, and corporal punishment generally (letter, 1 July), are violent. All punishment is a form of violence, since it must involve authoritatively imposing on another person an experience he or she would prefer not to undergo. So punishment in itself is a rotten idea. Unfortunately, try as they might, no human society has ever managed to do without it or think of a better idea.
Michael Grosvenor Myer
I have just seen the new art work by Martin Creed at Tate Britain, involving people running up and down the central gallery. After a minute or so I got bored and went to look at the Turners instead. I will not claim Turner is more relevant to modern life than Mr Creed, but at least he doesn't bore the pants off you.
Dr Michael Paraskos
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